The goal of this study is to determine which position, maneuvers or combination thereof generates the highest pressure at the EGJ as assessed by high-resolution esophageal manometry and thus greater or more robust contraction of the diaphragm.

This is a prospective, single-center study of adult (age ≥18 years) participants undergoing high-resolution esophageal manometry to assess the optimal method of diaphragmatic breathing. Included patients will complete two validated surveys, the Brief Esophageal Dysphagia Questionnaire (BEDQ) and the Gastroesophageal Reflux Disease Questionnaire (GERDQ). Patients will then undergo a standard protocol of supine and upright swallows with high-resolution manometry analyzed according to the Chicago Classification v4.0. After completion of the standard manometry protocol, participants will then perform a protocol assessing different techniques and positions for diaphragmatic breathing.

Inclusion Criteria:

• patients undergoing high-resolution esophageal manometry

Exclusion Criteria:

• prior esophageal or gastric surgery
• chest tube
• major concomitant illness
• sinus disease precluding manometry placement
• history of heavy alcohol or tobacco use
• poor comprehension and/or fluency of English language
• inability or unwillingness of individual to give written informed consent